Hunger and binge eating: a meta-analysis of studies using ecological momentary assessment.

Alissa A Haedt-Matt, Pamela K Keel

Journal: The International journal of eating disorders 2012;44(7):573-8

PMID: 21997419

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Plain Language Summary

Binge eating is a key feature of both bulimia nervosa (BN) and binge-eating disorder (BED). Impaired appetite regulation (i.e. excessive hunger) has been implicated in binge eating. This study is a meta-analysis of ten studies (180 participants) that explored hunger as an antecedent for binge eating. It focused on studies using Ecological Momentary Assessment (EMA), where a participant reports symptoms, affect, behaviours and cognitions close to binge-eating and in their natural environment. It found that hunger was rated significantly lower before a binge compared to before a regular meal. This suggests that excessive hunger may not be an antecedent to binge eating and support the anecdotal reports that BED eaters binge when they are not physically hungry. The authors suggest that binge eating may be a result of cognitive factors (e.g. eating in response to dietary rules) and/or negative feelings rather than physical hunger. The authors also suggest that the effectiveness of establishing a regular eating pattern and using selective serotonin reuptake inhibitors (SSRI) medications may therefore be effective in BN and BED for another reason other than reducing hunger.

Abstract

OBJECTIVE

Binge eating has been associated with increased hunger, suggesting a role for impaired appetite regulation. Ecological momentary assessment (EMA) is ideally suited to examine whether hunger is a precipitant of binge eating but results from such studies have not been systematically reviewed. This study provides a meta-analysis of EMA studies that have examined hunger as an antecedent of binge eating.

METHOD

Electronic database and manual searches produced seven EMA studies with N = 180 participants. Meta-analyses were conducted to compare: (1) pre-binge eating hunger to average ratings of hunger, and (2) pre-binge eating hunger to hunger before regular eating.

RESULTS

Across studies, hunger was significantly greater before binge eating compared with average hunger ratings, but was significantly lower before binge eating compared with before other eating episodes.

DISCUSSION

Excessive hunger does not appear to be a precipitant of binge eating because higher levels of hunger are observed before regular eating episodes. However, lower hunger before food consumption may contribute to the experience of a particular eating episode as a binge.

Address: Department of Psychology, The University of Iowa, Iowa City, Iowa , USA. [email protected]

DOI: 10.1002/eat.20868